Protein, Albumin, Bilirubin, ALT, ALP with GGT automatically reflex tested if ALP > 200
Sodium, Potassium, Urea, Creatinine
Calcium, Phosphate, ALP, TP, Alb
Specific IgE ("RAST")
Measurement of IgE to specified allergens can help to confirm allergies suspected on clinical grounds. Results must be interpreted in the context of a detailed clinical history, and neither positive or negative results are diagnostic in isolation. The allergens to be tested must be specified on the request. This test is not suitable for broad "allergy screening" in the absence of a history suggestive of an allergic reaction.
Skin Prick Testing
In many cases skin prick testing provides a safe and simple alternative to specific IgE measurement, but this does require referral.
Referrals are accepted for the investigation and management of patients who have suffered anaphylaxis and patients with the the following allergic conditions:
Clear allergic precipitants can be identified in only a small proportion of cases. Patients may respond well to regular treatment with antihistamines.
Skin-prick testing for a range of food allergens is available. "Screening" is not appropriate, and diet and symptom diaries often help to identify suspected foods for testing. Patients with life-threatening reactions benefit from detailed advice and individualised management plans.
Allergic Rhinitis and Asthma
Skin prick testing can help to identify significant aeroallergens in these patients, which may held in planning medical management. Pollen desensitisation may be offered under certain circumstances: patients will only be considered if adequate medical therapy has failed, and certain other suitability criteria are fulfilled.
Bee/Wasp Venom Allergy
Assessment of patients who have suffered severe reactions to bee or wasp stings is offered. In some cases desensitisation immunotherapy is indicated to prevent anaphylaxis in individuals at particular risk.
Antibiotic and Anaesthetic Allergies
Suspected antibiotic allergy (especially to penicillin) is common, and can usually be circumvented by the choice of an alternative antibiotic. In exceptional circumstances allergy testing may be appropriate. It is often important to exclude or identify allergy to local and general anaesthetic agents, so that future routine or emergency treatment can be given safely. A detailed history of the suspected anaesthetic reaction and the anaesthetic agents used are vital to successful assessment. Testing of serum tryptase levels immediately after an anaphylactic episode often aids diagnosis (see Laboratory Services).
Glucose Tolerance Tests
Appointments can be made via Diabetes Centre on 0121 424 0234. A service is available at Solihull - for information contact Laboratory Reception at Solihull on 0121 424 5531 / 0121 424 5526.
Blood tests to help in the investigations of these conditions are listed below and a guide to their use may be found in Test Profiles.
Connective Tissue Disease
This covers a wide range of relatively rare conditions including systemic lupus erythematosus (SLE), scleroderma, polymyositis and Sjorgren's syndrome. Rheumatoid arthritis is common, and may present initially with similar features. However, the early involvement of other organs (e.g. skin, kidneys, eyes, Raynaud's) may suggest an alternative diagnosis.
Includes a heterogeneous group of diseases, characterised by inflammation and necrosis of blood vessel walls. Presenting features may include fever, weight loss, fatigue, multi-system involvement (skin, nasal bleeding/crusting, arthralgia, myalgia, neuropathy), with raised inflammatory markers and abnormal urinalysis. As with connective tissue disease, rapid diagnosis and treatment is essential to prevent organ damage and death. Serological markers such as ANCA may be helpful, but are not diagnositc and their absence does not exclude vasculitis. Biopsy evidence of vasculitis is always preferable to confirm the clinical suspicion.
Clinical advice regarding the management of these conditions may be obtained from the department Medical Staff, or from the relevant clinical specialty (e.g. renal, medicine, rheumatology). Patients may be referred to Immunology or to Rheumatology for assessment.
Advice for Medical Practitioners
Advice regarding the investigation, treatment or referral of all patients with possible connective tissue disease and vasculitis is available from the medical staff. Advice out of normal working hours can be obtained from the on-call rheumatology, renal or medical teams (depending on the patient's particular problem).
Birmingham Heartlands Hospital
Only the fluid types below and specific analyses tabled are now allowable in Telepath and ICE. Where a fluid type or analysis is not allowable in Telepath please book as miscellaneous and then contact the Duty Biochemist before analysis is performed.
All fluids must be centrifuged and then analysed only if free from particles.
Conventionally diabetes mellitus has been diagnosed by high fasting or random blood glucose concentrations, or abnormal oral glucose tolerance tests (OGTT). Haemoglobin A1c (HbA1c) has been used to monitor longer term glycaemic control in patients with known diabetes mellitus.
In 2011, the World Health Organisation (WHO 2011) recommended that HbA1c measurements should also be used to diagnose diabetes in the majority of asymptomatic individuals, and this recommendation has been agreed in the UK (NHS Diabetes 2011).
HbA1c of 48 mmol/mol or more (≥ 6.5%) is consistent with diabetes: if the patient has no symptoms then a second HbA1c result must be obtained within 2 weeks, and if ≥ 48 mmol/mol (≥ 6.5%) confirms diabetes mellitus.
HbA1c values of 42 to 47 mmol/mol (6.0 to 6.4%) suggest a high risk of future diabetes. Such individuals should be offered structured lifestyle education and support to delay/prevent development of diabetes, and have an annual HbA1c test
The basic approach to clinical problems is suggested.
The medical staff of the department are happy to advise with the investigation of any problems.